Dissatisfied doctors can’t provide good patient care

The worst news in health care is not antibiotic resistance, drug-drug interactions, hospital acquired infections, lack of communication between systems of medical records, and certainly not the alarming rate of obesity in our youth.

The worst news is the increasing number of dissatisfied physicians.

The physician, also known in the system as a “provider,” has been the direct target of assault by the government. The logic has been that if the physician is squeezed to do less, he or she will order fewer tests, few medications, as a result of which the cost of medicine will be reduced. The same logic has been applied to reducing samples of medications to offices and placing more bureaucracy to get authorization for much needed medications and procedures. Simply, more stumbling blocks mean less cost.

But this logic has not taken into consideration a brewing rebellion by doctors.

Over the past decade, doctors have been squeezed by insurance companies with decreasing revenues and Medicare payment cuts while the cost of running an office has steadily increased. Insurance companies constantly send threatening letters to doctors to charge less and spend less time with patients. The advances in medicine have paradoxically caused more concern for doctors: We can do more, but we must contain costs, all the while afraid of being sued for missing a rare but deadly disease.

Doctors are broken. I see them walking around campus avoiding eye contact, hardly smiling. When time permits, few break out in quick psychotherapy sessions to complain about the system, the way cancer survivors do. They feel some relief knowing they are not alone.

To survive the pressure, fewer doctors are accepting insurance. More are going “concierge,” requiring an annual entrance fee. Many are not taking Medicare or government related insurances. Some demand a credit card on file for incidentals, as do hotels. Some are requesting fees for filling out forms, phone calls, prescription refills, in the same way attorneys charge for work in the client’s absence.

Does our society really think that angry, dissatisfied doctors will deliver better care?

What about Obamacare and Affordable Care Act? Insurance premiums will double again in 2015. Patients, too, are outraged when they find out about the large deductibles, large co-pays, and denial of authorizations for tests ordered by their doctors. Most doctors are not accepting or dropping this insurance because of all the hassles. Irritated patients, unable to express their frustration to the insurance companies, turn their anger at their doctors who are the face of the health care delivery. Many doctors are making patients sign forms that they are personally responsible for bills unpaid by Obamacare.

When I first started rounding in hospitals over twenty years ago, I was regularly asked why I was so happy, smiling all the time. I felt privileged to work in the best health care system in the world. Among the highest reasons given by aspiring medical students for choosing medicine as a profession is job satisfaction.

With the unleashed assaults on physicians by the government, stringent reporting requirements, and difficult third party reimbursement, the satisfaction with the practice of medicine is rapidly dwindling. Most of us spend three to five times as much on filling out forms and documentation than in the room talking to the patient who desperately needs us.

I no longer walk the floors of the hospital. The electronic medical record mandated by all hospitals are daunting. Technology and government regulation has become a large elephant squatting in between the patient and the physician: Neither can see the other. Required documentation will force office doctors not to round in the hospitals, creating further distance.

2014 marks the official disintegration of the world’s best health care delivery system. Doctors are busy taking care of patients. Unless patients wake up and fight for the providers of care, we are headed for the sickest system in the world.

Afshine Ash Emrani is a cardiologist and can be reached at Los Angeles Heart Specialists.

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  • Dr. Drake Ramoray

    I agree with this post 100%. I am laying the long term groundwork for a direct pay practice. The only thing I would add is the addition of ICD-10 amongst everything else that you have cited. Great post.

    • Bill Viner

      I was just about to add ICD-10. Also we need to add the changes just to maintain our board certification. For ABOG keeping up with the medical journals is no longer good enough. Now we do modules and retake a written exam. I just spent several thousand dollars in travel costs and 5 days out of the office to take this exam. I passed without studying which just tells me that it is unnecessary. Where are the evidence based studies that prove that more hoops to jump through make us better/safer doctors?

      • ninguem

        Did you read about the House vote to delay ICD-10?

        I know, the Senate and President remain as hurdles, but we can hope…….

        • Bill Viner

          No didn’t read it. It’s just temporary as they’ve already spent all that money developing it, so they have to use it eventually. It doesn’t affect me except if I ever want to work in US again, then I will have to learn it. I’ve been to a coding conference before and by the end of the 3rd day, I wanted to put a gun to my head.

        • Patient Kit

          Didn’t the Senate just vote to delay ICD-10 for a year? Now that it’s passed in both the House and Senate, I can’t imagine President Obama not signing it. Is there an ICD-11 on the horizon?

      • SarahJ89

        Five days??? Do they not realize you actually went to medical school???

        • Bill Viner

          The exam was only 2 hours. Finished in a little over an hour. Took me 2 days to get to US and 2 days back as I now work in NZ. Complete waste of time and money. Just an example of how the powers that be are placing too much pressure on us worker bees.

          • Lisa

            Let me get this straight. You work in New Zealand, but want to maintain your US license. If that is the case, I think complaining about the time spend is out of line.

          • Bill Viner

            You are missing my point. I’m guessing because you are not a doc? The post was about physician dissatisfaction and I was adding that in addition to all the usual workday hassles, even maintaining Board Certification is becoming too burdensome. It takes a huge effort (years of experience and written/oral exams) to get and keep certification (not state licensure, although that is also becoming so). Who knows where in the world my work will take me, so it’s best not to give up Board status. The problem is that the newer requirements have no evidence of improving patient care, which is the goal, right? So even the politically motivated ivory tower docs are worsening the situation for the lowly worker docs like myself. So please don’t tell me that I’m out of line unless you know what I’m taking about.

          • Lisa

            You are complaining about five days out of the office, while your colleagues in the US might spend several two out of the office.

            From my point of view as a breast cancer patient, I see a difference between doctors of different generations, with older doctors tending to use the treatment standards they are used to, while younger doctors are much more aware of new research and apply information from studies more easily. So I tend to think requirements to maintain board certificion and CE requirements are good things.

          • B Viner

            I am not old nor young, I’m halfway through my career if I live to work 30+ years. I didn’t say CE wasn’t good. I said taking an easy test that requires no preparation and offers no improvement in patient care is a waste of time and $. ABOG had 5 steps to complete to maintain and one of those is reading 30-45 medical articles a year, which is beneficial. Then they added an exam (step 6) which was so easy that a first year resident could pass. BTW a statement of fact is not necessarily complaining. If you are here just to express your frustrations as a patient then please don’t comment on my posts as I am only here to observe how my colleagues are handling the ACA and ICD10 amongst other things. Oh, and doctors that finished their training in 1985 or earlier are grandfathered in and don’t have to do the 6 step certification. They need it more than anyone.

          • SarahJ89

            It’s hard to imagine the testing company is so impoverished in their thinking that some arrangement couldn’t be made for online or exam taking at a medical facility in NZ. And yes, you’re smart to maintain your US certification. Life does take some twists and turns.

            Having said all that, I must say I totally envy you life in NZ.

  • guest

    Doctors are being treated abusively; if one expresses concern or points out inadequacies/inefficiencies in the systems we are forced to work in, we are branded “negative,’ or worse, “disruptive.”
    People who are abused tend to subconsciously identify with their abusers, and then in turn behave abusively towards those who have less power than they do. This is called “identification with the aggressor.” Under these circumstances, it becomes unlikely that patients will consistently receive thoughtful and empathic care.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    I love this post!!! This is precisely what I had in mind here: http://www.kevinmd.com/blog/2014/01/doctors-complain-resonate-public.html
    We need more like this, lots more, all day, every day….

    • Bill Viner

      I just hope it does some good. Although I don’t work in the US now, I am saddened by the changes in the system. I could never come back and work in it’s current state.

      • ninguem

        So……where did you go, if you don’t mind my asking?

  • EmilyAnon

    I am noticing a change in demeanor in my doctors. They don’t discuss their issues with me, but I can sense a kind of defeat in their manner. I’m sure it’s based on what’s been expressed for a long time on this blog. Doctors’ unhappiness will filter down to the patient.

    • SarahJ89

      I’m noticing a serious diminishment in the ability to make a diagnosis. It seems the goal is to decide which test to order. Doctors are not only visibly unhappy (with very good reason), they seem to actually be thinking differently now.

  • Patient Kit

    I agree with much of what you say and I sincerely empathize a lot with doctors. It’s clearly not what you signed on for and, from this patient’s POV, it’s a scary time to be sick in the US. That said, I will point out that the “best healthcare system in the world” may have been good for doctors but it was not working well for millions of Americans. But there is plenty about the ACA that is not working well either. I don’t think things will get better unless our system stops being, first and foremost, a big business whose main purpose is driven by the corporate profit motives of Big Health (insurance cos, hospital corps, pharmaceutical corps, etc).

    It’s all very disheartening. I’ve already had to be my own lawyer in court (and worked things out nicely and fairly). I can’t be my own oncologist. Unhappy docs, unhappy patients. We need to join forces and find a way to make Big Health corps very unhappy. <:-(

    • Lisa

      I second what you say, Kit.

      Doctors are getting squeezed, just like the rest of the middle class in this country. As long as we have medicine that is profit driven that is not going to change.

      • Patient Kit

        I really think cutting out the profit motive is the only real answer for both doctors and patients. Going back to what we had pre-ACA is not going to solve any of the problems that we discuss here and experience in real and sometimes devastating ways on a regular basis. The profit driven business model for healthcare has to go. It’s not, and never was, the best system for healthcare in the world. As long as we accept healthcare as a business, both doctors and patients will be treated like workers and customers — like we exist mainly to make money for others who own and run the business.

    • Alene Nitzky

      As a nurse who worked under big healthcare, I can see that things are not working for anyone except for the people at the top of the heap, the executive class of these corporations. I left the organization because dissent was not allowed, critical thinking was viewed as a threat, and the organizations will not listen to anyone who questions the way they are doing things. As a result, we end up with mediocrity at best, which is rapidly heading downhill to unsatisfactory and dangerous conditions for patients and providers alike. You are right in saying the public needs to be made aware. They need to speak out instead of accepting defeat.

  • QQQ

    “Most doctors are not accepting or dropping this insurance because of all the hassles. Irritated patients, unable to express their frustration to the insurance companies, turn their anger at their doctors who are the face of the health care delivery. Many doctors are making patients sign forms that they are personally responsible for bills unpaid by Obamacare.”

    I am afraid what we have seen so far is only the tip of the iceberg and I think a very small tip. This law has so many flaws that they have not even discovered yet.

    UnitedHealth Group (UNH) dropped thousands of doctors from its networks in recent months, leaving many elderly patients unsure whether they need to switch plans to continue seeing their doctors.

    This will prove that the doctor shortages will be real and travel and wait times to see a doctor will increase significantly, but that is okay, it is the consumer that will have to pay the extra gas mileage and waste more time of their day waiting to see a doctor they do not want to see!.

  • Lisa

    I think it is disingenuous to blame the problems in out medical system on Obamacare, even partially. The problems were pre-existing, so don’t blame the problems in medical care on Obamacare.

    Regarding Obamacare – Premiums didn’t double in 2014; in fact many people’s premiums went down especially when you consider the subsidies. How can you say that premiums will double in 2015? Yes, the plans offered have deductibles and co-pays, just as insurance plans have had in the past. At least now, people’s out of pocket maximum is capped at a lower amount than previous high deductible plans and there is no life time limit. Insurance companies have always denied authorizations for tests; this is not a new problem. And finally any doctor, I have seen has had me sign forms saying I am responsible for anything my insurance does not cover. This is nothing new.

    • SarahJ89

      I agree. This system has been broken for a very long time. In the past week I’ve met several people who are now insured, some via the Medicaid expansion, for the first time in their life. We’re talking people in late middle age.

  • http://laheartspecialists.com/ Afshine Emrani MD FACC

    Thank you everyone for the support on this post. We need both for the sake of physicians and patients alike to continue to voice our opinions through this very difficult transition.

    • Bob

      I find the comments totally uninformed and biased, except for those of physicians who worked in “the old system” [yes there was one] where the uninsured were treated on a “as needed” basis most often in ERs and their bills paid by taxpayers through DSH.
      ACA didn’t consider the fact that physicians and nurses are in short supply, in 2010 and are in even shorter supply in California 70% of the physicians won’t be taking new patients, while nationally the average is 3%%; most for any type, Medicaid, Medicare [growing by 4 million/year], exchanges, or commercial insurance. They will be able to survive without more for the few months it will take for the ACA to fail miserably. As for the millions of new Medicaid and taxpayer subsidized insured, unfortunately the only place they will find they can be treated is in emergency rooms once again, which in half the states that didn’t accept extended Medicaid and have reduced DSH payments will exacerbate problems.
      The old adage of measure twice cut once will show sage once more, as the poor and aged that are newly “found” will find no care, not free care, until ObamaCare is removed which will start today, as the number of insured grow and caregivers shrink!

      • SarahJ89

        “their bills paid by taxpayers through DSH.” Really? Not in my state which refused for decades to extend Medicaid to intact families. This meant if your child got leukemia the parents had to separate in order to get medical treatment. Most people took their child down to the large cancer hospital in the next state. To the credit of that hospital and the shame of my state, they did not refuse to care for these children. That neighbouring state spend millions caring for our children as the politicians in our state trumpeted proudly about our low taxes. So no, DHS did not pick up the bills in the Good Old Days.

        • Bob

          Sarah. Yes really they do and this is part of the problem hospitals have with ACA, as it reduces DSH which simply put is hospital bills not paid by any patients, uninsured, “dead beats” or just uninsured poor not qualifying for Medicaid and therefore is paid by taxpayers. Sort of like ObamaCare Medicaid increases and states exchange subsidies. Cancer is not treatable in emergency rooms and most states set “spin downs” causing what you cite, and is the major part of ACA I fully support. The good news there is cancer rates are falling and will fall farter and faster now, for that part of the ACA was long overdue and hopefully will be unneeded in the near future!
          But my problem with the ACA is there simply are too few physicians and nurses and all the money in the World can’t make 30% more by tomorrow!

          • Patient Kit

            Good to know that cancer will no longer be a problem in the near future for the US healthcare system. It’s still a huge problem now, especially for people who are currently suffering from cancer and for the millions of survivors who need followup care.

          • Lisa

            I googled cancer rates in the US, just for fun. The number of invasive cancer rates in the US dropped slightly between 2009 and 2010 from 459 new cases per 100,000 in 2009 to 446 new cases per 100,000 people. So yep, the rates are going down very slowly – I suspect that is because fewer people are smoking, there are now vaccines for the HPV reducing cervical cancer and because increases in colon cancer screening.

          • Patient Kit

            I had little doubt that we’ve made great progress on cancer. The fact that you and I are still here to tell our tales is further proof of that. But Bob made it sound like very shortly, it won’t be a problem at all. We can hope. In the meantime, it is still a problem to every single person who is diagnosed with cancer and to the people who love us. Just because it’s not as bad as it was in the past, doesn’t mean it’s not still a horrible disease for people still suffering from cancer. I just have little patience for minimizing the pain that cancer inflicts and that seems to me to be what Bob is doing here. We are individual human beings, not statistics. (Sorry Lisa, although I’m responding to you, my frustration is meant for Bob).

          • Bob

            Guess you’re too young to know why and how we got where we are today, and realize you can be a glass half full or a glass half empty.
            I remember my parents talking about the Spanish Flu that killed more in WWI than the war did, and growing up when TB and polio were the fearsome diseases and we all were vaccinated for smallpox; while today the World’s worse is malaria that kills 2,000 a day, but not a sole here.
            Have you been to Africa Kit? Or Arab lands or anywhere other than the US of A?
            Do you know anything about the Human Genome, or stem cells and when these replace todays caregivers, drugs and become cured, how will we care for everybody when physicians and chemists are switched to biologists that is happening right now?
            remember Kit when SS started in 1935, you had to be 65 before you got it, and then the average age at death was 62, so not too many folks made it, I recall. But insurance and hospitals don’t treat diseases, doctors and nurses do, and they do it well and should be treated well for all the time they spend treating us, most of us really glad they are around and want them to be treated with more respect including being paid what they are worth.

          • Lisa

            I think the whole middle class would like to be treated with more repect and paid what they are worth. We are all getting squeezed. But who/what determines what doctors are worth in a medical system that is designed to maximize profit for hospitals and insurance, not to maximize health outcomes for patients or doctor’s salaries?

          • Bob

            Who exactly is the middle class Lisa?
            I grew up thinking I was, but I wasn’t near that, but I didn’t mind at all. What are any of us worth Lisa? Certainly not physicians or nurses, who along with pharmacists and elementary teachers are the most respected professionals. Hospital costs since 1980 when DRGs came into being to make them more affordable have shoot straight up, and administrators are paid much more than doctors are. Hey the CMS Director is a Nurse and certainly makes more money not nursing. And we pay twice as much for drugs than other countries and the list goes on and on, but we aren’t getting squeezed by doctors simply because there are not enough of them. In all lands supply determines demand and cost.

          • Lisa

            I have no idea what any of us are worth. And I don’t know how to determine who is middle class, although I think many doctors would fit my definition of middle class. Perhaps you are no longer middle class when you don’t have to worry about money.

            We pay more for drugs than other countries because our government does not control prices. We pay more for medical care in the US because medicine is a big business. Other western countries recognize medical care is a public good and controls prices, either through a national health system or by controlling the profits that can be made by insurance companies and hospitals. I’d rather pay for medical care through taxes and have it available to everyone than our system.

          • Patient Kit

            LOL! (and I’m laughing to keep from crying here, Bob.) Thanks for calling me “too young” but I’m in my fifties. It’s true, I don’t remember 1935. But I’m not buying the idea that SS worked better when nobody lived long enough to collect it. By those standards, our healthcare system would be better off if people still died sooner and younger. It was a lot less costly when people who got sick just died, wasn’t it? But that doesn’t mean it was better then. Just less expensive.

            And yeah, I don’t remember polio firsthand although I do know the history. But I do remember AIDS vividly. I lost some very close friends to AIDS. It was devastating. But, to be honest, I’ve never seen the point of competitive pain. Things might have been worse in the past. But whatever awful thing people are going through right now is bad for them. It serves no purpose to say:, hey! It was way worse in the past, so your pain is nothing in comparison!

            Have I ever been outside of the US of A?, you asked condescendingly. Why yes, Bob, I have. As a matter of fact, I’ve worked with people all over the world building coalitions on social justice issues. People in Haiti, South Africa, China, Mexico, Guatemala,and other countries. I’m very aware of how much worse things are in many countries, healthcarewise. But things are also better in many countries like Canada, New Zealand and most of Europe.

            What does any of this have to do with how I feel about doctors? I love and respect and need my doctors and doctors in general. But I still think it’s obscene for Americans who need chemo to go without it because they can’t afford it. Who knew that, as you suggest, there is unlimited free treatment in American hospitals for all who can’t afford to pay the astronomical bills?

            And you’re calling us uninformed?

          • Bob

            Yes I am, bigoted as well, but I get the point that you are a socialist by nature. Not that I mind that as so was Christ and many others.

            History is a good subject as it repeats itself, everywhere in the World. As for dying younger in the past that’s simply a fact, as is life expectancy going into the 80′s. It’s helped along by NICE in Europe that some here call death panels.

            So if your in your 50′s you remember back about 40 years, to remember President Reagan and perhaps Senator Proxmire’s “Golden Fleece awards” on government waste; now $1.2 trillion a year, most in Medicaid and Medicare.
            I recall AIDS, and find its devastation in Africa especially alarming as I do the Clinton AIDS cocktail costing a dollar a day while taxpayers here paid about $10,000 a year. My sadist recall are l the hemophiliacs killed with tainted factor VIII.
            Building coalitions on social Justice all over the World, seems to make you an attorney, not in the top 100 most respected, except in politics, but I agree with you healthcare in most nations suck, but find it very high in the US, just not available and affordable to too many, and it might surprise you to know I support a one payer system, especially since those who have one don’t let corporations and hospitals gouge them as we do here. But my problem with this is mainly that while we have too many without care, we have too few health people, i.e. docs, nurses and others. I would start this with the young a healthy as they have less problems, money and time. PA’s and NP’s could do this well and economically.
            But if we spend ourselves into oblivion as we are perhaps on the way to doing, it won’t matter at all. But it’s April Fools day and we just don’t know yet who to crown!
            . . .

          • Patient Kit

            Call me a socialist if you must, even though I’m not a socialist. But please do not call me an attorney. I am not a lawyer. I do believe a single payer system may be our best hope. I also think we should be subsidizing medical education for doctors. Not only would their huge personal debt be taken out the equation but our pool of potential doctors would grow to include those who previously never considered med school because of the cost. Both patients and doctors are hurting in the system we have now. We don’t have the best healthcare system in the world if millions of our citizens can’t afford or access it.

          • SarahJ89

            Um Bob, the least you can do is get your terminology straight. That’s “spend down.” As in spend down almost every penny you have. As in sell your reliable car because you can’t own anything worth more than $1500. And then try to get work in junker car in a rural state with no public transport.

            By the way, Lisa totally has her facts straight. I was an intake worker by profession so I know the ins and outs of the “Medis” (not midis). You clearly do not.

      • Lisa

        Yes, ERs have to treat people, but that treatment consisted of stabalizing patients and discharging them. ERs can’t don’t treat chronic disease, don’t treat cancer, don’t replace joints. In my state adults could not get medicaid unless they were disabled. I’ve always had good insurance, but realized as a cancer patient i was a job loss away from being unisurable. No more.

        I hope the people in the states that didn’t extend medicaid vote accordingly. The politicians in those states have a lot to answer for, imo.

        • Bob

          Lisa, you missed a main treatment option that is admitting them into the hospital from the ER.
          And in all states being disabled isn’t a Medicaid issue as Medicare is for the disabled and blind as well as over 65. I think you have your MIDI’s mixed up.
          If there wasn’t $1.2 trillion in waste, fraud and abuse, $1 of every $3 spent there would be enough money to pay for everything; but this isn’t a money issue. It’s a people issue as it takes 10 years to produce a physician and 5 for a nurse. And with 30% of them not taking new patients and some being cut off from existing patients by ACA and Medicaid the lowest payer do you think there are a lot of students willing to incur hundreds of thousands in student loans to work for and average $134,000 a year, much less if most patients are Medicaid.

          • Lisa

            You can’t get medicare until you have been disabled for two years, if you are under 65. I don’t have my MIDI’s mixed up.

            All the emergecy room has to do is stabalize someone; if you show up at an emergency room uninsured and in severe pain from OA, they won’t admit you for a hip replacement. My son showed up at an emergency room becuase he was having severe abdominal pain with blood in his stool. He got a cat scan, they determined he didn’t need immediate surgery, and they released him, telling him to get a colonosctopy. He was lucky – he had insurance. If he hadn’t, I don’t think his problem (ulcerative colitis) would have been diagnosed. Other examples, one of my friends had a heart attack and was admitted for surgery. However, as he was uninsured, he has had problems with followup care. In addition, he has been unable to get care for his gout attacks, which are disabling. There are all kinds of stories but the simple fact that treating illness through the ER just doesn’t work that well.

            I have been hearing about a shortage of doctors for years. That shortage of doctors is regional; that could be fixed by by more student loan forgiveness programs, in my opinion. Medical schools could also open more slots. I live in CA and I do not see a shortage of doctors. I do see new clinics and medical offices opening up.

            I do think the shortage of nurses is overstated. New graduates from nursing schools were having trouble getting jobs several years ago, in part because older nurses were not retiring due to the recession and less demand. Certainly, my nurse friends in this area don’t get all the shifts they want. |

            I am going to toss this out just for fun; if many doctprs work for corp med and they are in such short supply, I think that conditions are ripe for a strike by doctors. I’d join you on the picket line. Seriously, as long as medical care in America is driven by profit, the ACA is the most feasible way to get more people insured.

          • Bob

            So what you’re saying is in California disabilities are covered by MediCal for two years until Medicare takes over?
            And it seems you believe that ER’s should replace hospital admitting offices, and anyone found with treatable conditions should be admitted from the ER? O.K. with me and it removes the need for routine doctors visits. But doing this would require specialists in all fields of medicine, wouldn’t it, for ER physicians are established for emergency medicine cases like auto accidents, shootings, broken bones, heart attacks, strokes, etc. and not individuals disease states, right?
            I am surprised to see you live in California which reports say 70% of physicians won’t take new patients. But you aren’t a new patient I guess. While I’m sorry your nurse friends don’t get the shifts they want, they are all employed, which is more than many can only hope for.
            Do you know about Canada’s system where you have to wait long times for operations? What do you think will happen here when costs are frozen since we are in debt as a nation? Kind of makes you wonder if we will run out of healthcare worker or money first, at least it does me.

          • Lisa

            In CA, prior to the ACA, childless adults who were not disabled could not get medi-cal. If you were disabled you could get medi-cal. If you get SSDI, you are not eligible for medicare for two years. Now childless adults can qualify for medical based on income.

            I don’t believe ER should replace the hospital admitting office; the point of the examples I gave is to indicate that treating anything other than emergencies in the ER doesn’t really happen and it is silly to say that the unisured can be treated in the ER on an as needed basis. With that system a lot of people who needed treatment didn’t get it.

            I know a fair amount about Canada’s health care system as it relates to breast cancer patients. Their wait times for treatment are about the same as outs and the treatment patients receive is compares to the teatment women recieve here. In general, the Canadian’s I’ve talked to say that wait times for urgent surgeries are not a problem and they are happy with their medical system. There more of a wait time for elective surgeries, but that is a trade off. They like not having to worry about bankruptcy and can’t imagine dealing with our medical system. By the way, the folks I talk to in England say the same thing.

            If 30% of doctors in CA are accepting new patients, I think that is more than enough to handle the ‘influx’ of new patients under the ACA. I do question the 70% figure, however. I changed insurance plans during open enrollement this year, so checked to see which of my doctors would be preferred providers under my new plan. I noticed that all of the doctors in the group of independent doctors my pcp is affiliated with are taking new patients. The other major medical group in my area is actively advertising for patients. There is a disconect with what you are saying.

      • Patient Kit

        Really? You’re going to start by dismissing all comments here by patients and docs who don’t totally agree with you as uninformed and biased? The great thing about having discussions with people who don’t all agree with us is that, if we listen, we will likely learn a few things about others’ experiences and perspectives, which can lead to real empathy.

        If our good old healthcare system was so good pre-ACA and all Americans were able to get all the medical care they needed with taxpayers picking up the tab, why is the #1 reason, by far, for filing for personal bankruptcy, overwhelming medical bills?

        The ACA has a lot of problems but our system was broken long before the ACA. I get my “uninformed” POV from living out here in the real world where millions of Americans have been unable to access healthcare in the US pre-ACA for a long time.

        I was diagnosed with ovarian cancer last year after I was laid off and lost my insurance. My dx was pre-ACA’s pre-existing conditions clause by more than a year. No insurance company would cover me for cancer because my condition was pre-existing. How do you feel about that clause of the ACA? Are you seriously trying to tell me that I could have gotten testing, specialists, surgery, chemo, frequent followup monitoring, anything I needed to
        treat my cancer and the taxpayers would have paid all my bills? Well, actually, ultimately we (the taxpayers) did pay my bills when I qualified for Medicaid. But first I had to lose everything in order to qualify for Medicaid. I paid my taxes for 35 years previos to this calamity, btw. So, I don’t feel like our government “gave” anything. I assure you that I’m well informed about how badly our good old healthcare was working — for me and millions like me.

        The ACA sure isn’t the whole answer. But going back to your good old days isn’t the answer either.

  • Patient Kit

    Doesn’t NZ have an extensive good public health system where all citizens can get “free” medical care? As I understand it, NZ’s public healthcare system is supplemented by a private NONPROFIT insurance system. Please correct me if I’m wrong or oversimplifying, but my main point is that NZ does not have a system driven by corporate profit motives. I think that’s the direction the US should be headed — not backwards to what we had pre-ACA.

    • guest

      You think that, and a lot of us think that, but as long as we have a government that is controlled by special interests like insurance companies, large hospital chains and pharmaceutical companies, that is not the direction our country will be likely to head.

      • Patient Kit

        Sadly, I know that. I think it’s in my nature to fight for what I believe in until I’m bloody, even when the odds seem almost impossible. Head, meet brick wall. Maybe my heart trumps my head too much. But I do have my days when I’m ready to just throw in the towel. Dealing with our healthcare system is so exhausting. If I didn’t have a cancer dx, I could easily see myself slipping into avoiding going to any doctors as much as possible. I know way too many peeps who only go to a doctor if absolutely necessary. And all too often that turns into going too late. Sigh. <:-(

    • Bill Viner

      We need to simplify, simplify, simplify. The good thing about fee for service it it’s simplicity. A public/private system could work fairly well as it does in NZ, but everyone would have to sacrifice a little for the good of all. My pay is a little less but my free time is significantly more and my stress level is way down.

      • Patient Kit

        A public/private (nonprofit) system sounds good to me, for both patients and doctors.

  • buzzkillerjsmith

    I just got back from a backpacking trip to the Wenaha-Tucannon Wilderness today. The other guys on the trip, all intellgent and pretty informed about the world, have no idea at all about the travails of docs. Not on their radar screen at all. A couple did complain about their high hospital bills.

    No one cares about our problems, nor will they. Abandon all hope–then go backpacking.

    • SarahJ89

      There are certain professions–teaching, medicine, tax accounting from January to April each and every year–that one simply cannot grasp unless/until one experiences them. Oddly, these are the very professions people feel the freest to toss stones at.

      • SarahJ89

        Law enforcement. I gotta add law enforcement to the list. I simply cannot imagine what it’s like to go to work each day not knowing if you will come home. Denial would be your friend in a situation like that.

    • rbthe4th2

      Some have and tried to do something about it. I was kicked to the curb by docs, with no care in the area. So don’t complain about those of us who have tried – like others – and failed because of your own brethren.

  • http://laheartspecialists.com/ Afshine Emrani MD FACC
  • rbthe4th2

    Let me tell you as a patient, I’ve been on the very brutal end of the anger and dissatisfaction of doctors. This was after trying to help. Some of the items, doctors have themselves to blame when someone tries to help. I’m not the only one.